The association between hypertension-specific care management processes and blood pressure outcomes in US-based physician organizations

Wong, Ken; Smalarz, Amy; Wu, Ning; Boulanger, Luke; Wogen, Jenifer

doi:10.1016/j.jash.2011.08.002

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Adherence to process of care, quality measures for hypertension has been found to have mixed associations with lowering blood pressure (Wong, Smalarz, Wu, Boulanger, & Wogen, 2011), which supports our findings of no consistent associations between the structure of QI interventions and outcomes. Further research into what specific components of QI interventions are more effective is needed.…”

Section: Discussionsupporting

confidence: 85%

Family Physicians’ Quality Interventions and Performance Improvement for Hypertension through Maintenance of Certification

Peterson

Blackburn

Puffer

et al. 2016

Journal for Healthcare Quality

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Section: Discussionsupporting

confidence: 85%

Family Physicians’ Quality Interventions and Performance Improvement for Hypertension through Maintenance of Certification

Peterson

Blackburn

Puffer

et al. 2016

Journal for Healthcare Quality

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“…These findings may not be suitably reflected by statistical comparisons, as our relatively small number of investigative sites resulted in large standard deviations which made formal statistical testing somewhat challenging. These findings are consistent with those observed in a larger hypertensive study cohort (diabetic and non-diabetic patients) using the same 28 study sites that was published previously [18]. That study, however, identified which specific practices were associated with BP control, with results suggesting that the use of physician education regarding patient medication compliance, the use of systematic processes for hypertension screening, and the maintenance of hypertensive patient lists with clinical characteristics were all associated with improved BP control.…”

Section: Discussionsupporting

confidence: 93%

“…Study subjects were required to have a diagnosis of hypertension (ICD-9-CM 401.x, 402.xx, 403.xx, 404.x, or 405.xx; or written diagnosis of hypertension in doctor’s notes) during the preceding year. Overall diabetes and obesity prevalence were calculated and are presented for all hypertensive patients identified in the original study of all hypertensive patients published previously [18]. For inclusion in this study, patients were also required to have a diagnosis of diabetes during the previous year, which was identified via ICD-9 codes (250.x) or clinical documentation in the patient’s medical record.…”

Section: Methodsmentioning

confidence: 99%

Impact of care management processes and integration of care on blood pressure control in diabetes

Wong

Boulanger²,

Smalarz³

et al. 2013

BMC Fam Pract

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BackgroundFragmentation within health care systems may negatively impact the quality of chronic disease patient care. We sought to evaluate the relationship between care management processes (CMP), integration of services, and blood pressure (BP) control among diabetic patients.MethodsRetrospective chart reviews were performed for a random sample of adult diabetic hypertensive patients (n = 2,162) from 28 physician organizations in the United States (US). A modified version of the Physician Practice Connection Readiness Survey (PPC-RS) was completed by the chief medical officer at each site. The PPC-RS measured health system organization, delivery system redesign, decision support, clinical information systems, and self-management support, and an integration scale measured structure, functions, and financial risk. Correlations between PPC and integration scores and BP outcomes were assessed using Spearman correlation coefficients.ResultsApproximately 39.9% of diabetic patients had controlled BP. Mean total PPC score across sites was 55, with highest mean scores for health system organization (81), followed by design support (60), clinical information systems (57), self-management support (39), and delivery system redesign (39). Mean integration score was 46 (SD 27, range 4–93), and means of subscores were 64 for structure, 33 for financial risk, and 42 for function. Clinical information systems subscore was correlated with uncontrolled BP (r = −0.38, p < 0.05), while association with total PPC score was strong but not significant at p < 0.05 (r = −0.32). Total integration score and the structure subscore were significantly correlated with BP control (r = 0.38, p < 0.05, and r = 0.49, p < 0.01).ConclusionsThis study suggests that CMP and service integration may be associated with better outcomes in diabetes, though results were mixed and limited by a small number of participating sites. Primary care implementation of integrated electronic medical records may have a beneficial effect on patient outcomes for diabetes and other chronic diseases.

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“…Disease management programs have been widely implemented for common conditions such as hypertension, diabetes, and heart failure [5] , [6] , [7] . These programs generally include tools such as population-level screening, laboratory result monitoring, telephone-based outreach by nurses, and disease-specific medication titration protocols to achieve evidence-based and disease-specific clinical goals.…”

Section: Introductionmentioning

confidence: 99%

CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management

Miller-Rosales

Sterling

Wood

et al. 2017

Contemporary Clinical Trials Communications

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Background/AimsCardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting patients who have persistently not met goals of CVD risk factor control.MethodsInformed by published evidence, relevant theoretical frameworks, stakeholder advice, and patient input, we developed a group-based intervention (Changing Results: Engage and Activate to Enhance Wellness; “CREATE Wellness”) to address the complex needs of patients with elevated or unmeasured CVD-related risk factors. We are testing this intervention in a randomized trial among patients with persistent (i.e > 2 years) sub-optimal risk factor control despite being enrolled in an advanced and highly successful CVD disease management program.ResultsThe CREATE Wellness intervention is designed as a 3 session, group-based intervention combining proven elements of patient activation, health system engagement skills training, shared decision making, care planning, and identification of lifestyle change barriers. Our key learnings in designing the intervention included the value of multi-level stakeholder input and the importance of pragmatic skills training to address barriers to care.ConclusionsThe CREATE Wellness intervention represents an evidence-based, patient-centered approach for patients not responding to traditional disease management. The trial is currently underway at three medical facilities within Kaiser Permanente Northern California and next steps include an evaluation of efficacy, adaptation for non-English speaking patient populations, and modification of the curriculum for web- or phone-based versions.ClinicalTrials.gov IdentifierNCT02302612.

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The association between hypertension-specific care management processes and blood pressure outcomes in US-based physician organizations

Cited by 6 publications

References 11 publications

Family Physicians’ Quality Interventions and Performance Improvement for Hypertension through Maintenance of Certification

Family Physicians’ Quality Interventions and Performance Improvement for Hypertension through Maintenance of Certification

Impact of care management processes and integration of care on blood pressure control in diabetes

CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management

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